When 63-year-old Billy Houston learned that his prostate cancer not only had returned but also had spread to his lungs nearly a decade after a radical prostatectomy, he chose to go to a top cancer center with multiple support services — Memorial Sloan Kettering. Today, at age 66, his disease is undetectable, his depression has lifted, and he’s found deep satisfaction in helping others through MSK’s online support community, Connections.
Every few days, Navy veteran and former Federal Reserve employee Billy Houston logs on to Connections, Memorial Sloan Kettering’s vibrant online community for people with cancer, their caregivers, and survivors of the disease. His time there is spent giving and receiving support, information, and inspiration.
On Connections, Billy recounts how he knew his risk for cancer recurrence was high in 2003, when surgeons at his local hospital first removed his prostate and found that the tumor had started to spread, or metastasize, beyond the prostate. His Gleason score, which pathologists use to estimate a prostate cancer’s aggressiveness, was also ominously elevated.
Despite having his prostate and the surrounding cancerous tissue removed, Billy’s level of PSA (prostate-specific antigen) began to rise again in 2010 — a possible indication that his cancer had returned. Thirty-nine sessions of targeted radiation treatment over the course of eight weeks failed to alter this reading.
Then tests following a PET/CT scan showed that he had a cancerous nodule in his left lung. The former smoker went back to his local hospital for surgery to remove the mass along with an entire lobe of the lung. Examination of the excised tissue revealed that the mass was not primary lung cancer but in fact prostate cancer that had spread to the lung.
“Getting this information after enduring one of the most painful surgical experiences imaginable does something to your psyche,” Billy later wrote on Connections. “At that point I knew I had to go to MSK for my treatment.”
A Positive Outlook
“Prostate cancer can be indolent [quiet] for many years before it recurs, and for some people, it manifests as metastatic disease,” explains MSK medical oncologist Dana Rathkopf, who saw Billy for the first time in 2011. “Metastatic prostate cancer is often not curable, but it is treatable, typically with hormonal therapy to inhibit the production of testosterone [which fuels the growth of prostate cancer cells] — an approach that for most people can work for years before the cancer starts to grow again.”
And in fact, a few months after starting on hormone therapy, Billy’s PSA reading dropped to undetectable levels — and has remained so ever since. Dr. Rathkopf continues to closely monitor him with physical examinations and blood and imaging tests.
“There’s reason [for people like Billy] to stay positive,” notes Dr. Rathkopf. Since 2010, five new drugs with a proven survival benefit have been approved for men with metastatic prostate cancer whose disease has progressed after taking hormone therapy.
MSK helped develop several of these new treatments, she explains. “Most notable are therapies like abiraterone acetate and enzalutamide, which target the androgen receptor and have changed how we treat patients with this disease.”
Dr. Rathkopf notes that not all patients will respond to these treatments, and those who do will eventually experience progression of their disease despite their initial response. “But we’re working hard to develop newer drugs that target pathways specific to prostate cancer in an effort to allow people to live longer with a good quality of life,” she says.
Dealing with the Downsides
Billy has had to cope with side effects from the hormone therapy that’s controlling his cancer, including fatigue, weakness, night sweats, and loss of libido and muscle mass. He takes walks to keep fit. “Unfortunately, I acquired asthma from the lung surgery that took half of my left lung, and now I have to carry an oxygen tank to enable me to walk,” he says. “If I don’t use it, I’m not going to get very far, but I don’t want to reduce my activity level. I refuse to accept that.”
These side effects can be scary, he says, “but it’s nice to know that MSK offers resources like the Sexual Health Program that can address some of them.” MSK also provides services such as social work, physical rehabilitation, and complementary therapies. Billy didn’t end up using those particular options, but he says, “There’s a certain level of comfort and security about MSK that I don’t believe I would get anywhere else. I feel safe. They have my back.”
This was especially evident when Billy became depressed after learning he had metastatic prostate cancer and also losing his younger brother to suicide. He reached out to MSK’s Counseling Center for someone to talk to. “Depression is slow and insidious; I was just sinking into an abyss, and losing my brother was the tipping point for me,” he recalls.
He felt his mood lifting after meeting with psychiatrist Andrew Roth, who also prescribed an antidepressant. “Prior to seeing Dr. Roth, I was a mope, just waiting to die,” he recounts. “I’ve learned that it helps to take a completely different view of your life and your future than you had before your diagnosis. Cancer is not a death sentence. I now see it as a chronic condition that I need to manage. And in the meantime, I will continue living normally.”
Focus on Hope, and on What You Love
Billy has also found it heartening to support and encourage others with cancer by sharing much of his own experience with the community that regularly gathers on Connections.
“I try to live each day as if I don’t have this terrible disease,” he says. “My advice to others living with metastatic cancer is to focus on the things you’ve always loved doing. You don’t have to try to find a reason to keep fighting cancer, but instead you need to see the reasons that are right there in front of you.” His personal joys include cooking and vacationing in Cape Cod with his wife and friends every year — and, as of 2012, spending time with his granddaughter, Collette.
“Colette being born was one of the happiest moments of my life!” he says. “Maybe I’ll survive to see her go to kindergarten or even graduate from college. I know it sounds ridiculous to entertain such unlikely hopes, but when hope is what sustains you, you just hope. And hope. And hope. Nobody lives forever, but I’ll take every second of time I get. I live for the times I see her.”